| NPI | 1811906357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA ANN KETCHUM Chief Pharmacist 662-286-5747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MS 03051/01.1) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-11-17 |